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City of Santa Ana <br />Donatiof7 Request <br />City Manayer's Office -M -37 <br />20 Civic Center Plaza <br />P.O, Box 1888 <br />Santa Ana, CA 02702 <br />(714) 647.5200 <br />o- e <br />S 100 V Date Needed: 4/20/2017 Ma oriCouncilmember: <br />t Nd Y Ut IIC�gS <br />:Direct ant Amount <br />Requested: <br />Name: John Hacker <br />Tine: <br />Veterans Coordinator <br />Address: 1901 East 4th Street <br />_ <br />!Description of <br />City, State, Zip: !Santa Ana, California 92705 <br />Phone: <br />714- 953 -5757 - <br />.Email: fhackero@oneoc.or9 <br />'Fax: <br />Benefit: <br />aocal community non profit Providers <br />Applicant signature: <br />-¢.. e. ,r'� -Jed 4 0(z`r •. <br />Dat jt •. _ _ <br />Name: OneOC <br />Tax - Exempt Status: Is your organization a non -pro Flt or public tax-exempt organization as <br />under Section 501(c)l3) of the internal Revenue Code? <br />Select One <br />® Yes O Na <br />If No, you will only qualify for a credit for City - related costs far yourrequest (l.e, permit fees, <br />-- <br />_ - -- - - <br />!staff time, rental rates for facilities or equipment, etcJ.Costs for City services vary and if <br />If Yes, <br />;approved,riedif may or may not raver full cost of re quasi ad City servlces. <br />Tax ID R: <br />City services Crede <br />Amount Requested: <br />S 100 V Date Needed: 4/20/2017 Ma oriCouncilmember: <br />t Nd Y Ut IIC�gS <br />:Direct ant Amount <br />Requested: <br />$ , Event Date: ,�«°"'� Event7ime: <br />;Event Location: <br />",Address. <br />Santa Ana Municipal Stadium <br />City, state, Zip <br />!Description of <br />One Day rental for the Stadium for the Homeless Veterans "Stand up" <br />Event l Purpose: <br />!'!,Community <br />To reach out and assist the Homeless veterans with a place to get services from <br />Benefit: <br />aocal community non profit Providers <br />Applicant signature: <br />-¢.. e. ,r'� -Jed 4 0(z`r •. <br />Dat jt •. _ _ <br />Mail: City Manager's office -M -31 Email: donationrequestC @ santa- ana.org <br />20 Civic Center Plaza Fax: (714) 647.6954 <br />P.O. Box 1989 <br />Santa Ana, CA 92702 <br />uon,'r ww I w t fi 04:: - <br />F 'IpbiSiiy �1er v��S `,.:� <br />tat, 415a m 9 S'ignmturu: pate. <br />Revised 01/05/2017 <br />v <br />